Dear Editor,

Despite being a common and treatable cause of heart failure in older adults, cardiac transthyretin amyloidosis (ATTR-CM) is still not well known. In a prospective cohort study involving hospitalized patients with heart failure with preserved ejection fraction (HFpEF) and left ventricular hypertrophy, wild-type ATTR accounted for approximately 13% of cases. This discovery underscores the imperative for systematic case identification within cardiology and nuclear medicine. [1].

Bone-avid SPECT tracers (99mTc-PYP/DPD/HMDP) enable non-biopsy diagnoses in appropriate clinical contexts, whereas amyloid-targeted PET agents improve diagnostic and research functions by facilitating quantitative evaluation. Translational and initial clinical investigations employing 18F-florbetapir and 18F-florbetaben have illustrated targeted myocardial binding to amyloid, the viability of identifying early or subclinical disease, and associations with disease burden and functionality [2–3]. Combining PET with advanced CMR (native T1, extracellular volume, and late gadolinium enhancement) in a multiparametric way can improve noninvasive phenotyping. When used with clinical and lab data, it may help tell the difference between ATTR and light-chain amyloidosis [4].

Looking ahead, standardized quantitative PET metrics, like SUV-based indices or kinetic parameters, could be used as objective biomarkers to record how well disease-modifying therapies, such as tafamidis and RNA-targeting agents, are working. Still, these endpoints must be tested in groups of people from multiple centers. To ensure that results can be reproduced and compared across centers, it is important to standardize the processes of acquisition, reconstruction, and analysis based on new societal guidelines [4]. Another advancement appropriate for incorporation into nuclear cardiology workflows is deep-learning–based automated ATTR diagnosis utilizing 99mTc-PYP SPECT imaging [5].

In summary, amyloid-targeted PET and hybrid PET/CMR don’t replace the well-worn SPECT pathways; they round them out. Together they make quantitative phenotyping more straightforward and help clinicians actually follow treatment trajectories rather than just snapshot them. Getting these tools into everyday clinics and into trials will hinge on tight, multicenter standardization—ideally with an assist from AI-driven analytics to keep the measurements consistent and, frankly, usable.

Keywords: Amyloidosis, Deep Learning, Magnetic Resonance Imaging, Positron-Emission Tomography, Technetium Tc 99m Pyrophosphate, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed.

Abstract

Introduction: Triple-negative breast cancer (TNBC) accounts for 15-20% of all breast cancers and is associated with a high recurrence rate and poor prognosis. This study aimed to determine the predictive value of [18F]FDG PET/CT metabolic parameters for the occurrence of metastasis in patients diagnosed with triple-negative breast cancer (TNBC).

Materials and Methods: This was a 2-year retrospective descriptive and analytical study. All patients diagnosed with TNBC who underwent [18F]FDG PET/CT as part of the extension workup were included. We sought an association between the occurrence of metastases and various metabolic parameters of PET/CT.

Results: A total of 48 patients were enrolled, with a mean age of 49.8 ± 12.6 years. The tumor was unilateral in 93.7% and multifocal in 8.3% of the patients. The predominant histological type was invasive ductal carcinoma (81.2%). The mean tumor size was 38.5 mm, with a mean SUVmax of 7.4 and a mean MTV of 82.4 cm3. Over 2 cm³of patients had metastatic disease. The most frequent secondary sites were the bone (16.7%) and lung (10.4%). PET/CT was used to restage all patients after the initial CT scan. Analysis of the influence of specific clinical and metabolic variables on the occurrence of metastases showed that age > 50 years, tumor size ≥ 20 mm, bilateral involvement, presence of multifocal focus, SUVmax ≥ 5, and MTV ≥ 50 cm3 were associated with the occurrence of metastases in patients.

Conclusion: Triple-negative breast cancer is an aggressive histological subtype that is avid for FDG. Our study showed an association between metabolic parameters on PET/CT and the occurrence of metastases in TNBC patients

Keywords: Breast cancer, metastasis, Positron-Emission Tomography, triple negative

Abstract

Physicians commonly use positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose (FDG) to stage and monitor lung cancer. This report describes the case of a 63-year-old man with biopsy-proven lung adenocarcinoma and known brain metastases. The initial PET/CT scan at 60 min after the injection did not clearly show the intracranial lesions because of the brain’s natural uptake of the tracer. A delayed scan at 120 min markedly enhanced the lesion-to-background contrast and identified multiple FDG-avid metastatic foci. This case illustrates the clinical importance of delayed PET/CT imaging in enhancing the diagnostic precision of intracranial metastases in patients with lung cancer.

Keywords: Brain Neoplasms/secondary, Fluorodeoxyglucose F18, Lung Neoplasms, Positron-Emission Tomography and Computed Tomography, Time Factors.

Introduction

An occipital spur is an abnormal bony protrusion, also known as exostosis, that generally develops at the external occipital protuberance (EOP), a noticeable ridge on the posterior aspect of the skull. EOP can present in three distinct forms: type I (smooth surface), type II (crest-like shape), and type III (spine-like appearance) (1,2). They are generally associated with spondylosis or osteoarthritis, particularly in individuals who have experienced chronic pressure in the cervical spine or surrounding areas, and may also develop because of repeated trauma or inflammation in the region (3,4). While typically asymptomatic, occipital spurs may occasionally cause discomfort or pain, particularly if they compress nearby soft tissues. This compression can sometimes result in occipital neuralgia, characterized by sudden, sharp pain at the back of the head or upper neck due to irritation or pressure on the occipital nerves (5).

Abstract

Introduction: Frontal sinusitis is a rare but potentially serious infection that can lead to intracranial complications such as brain abscesses. Herein, we present a case of a brain abscess secondary to frontal sinusitis with a posterior table defect, treated using a combined surgical approach.

Case: A 59-year-old man presented with seizures and loss of consciousness one month after being diagnosed with acute sinusitis and preseptal cellulitis. Computed tomography (CT) revealed a brain abscess in the patient’s frontal lobe. Following surgical drainage, an 11 mm defect was identified in the posterior table of the frontal sinus, which was repaired through an additional surgical intervention. Endoscopic sinus surgery was performed to remove the pathological tissue, followed by an external osteoplastic approach with fibrin glue and hemostatic agents, and placement of an otologic ventilation T-tube in the frontal sinus ostium.

Conclusion: Intracranial complications of frontal sinusitis can be successfully managed using a multidisciplinary approach and appropriate surgical techniques. Early diagnosis, treatment timing, surgical planning, and maintenance of frontal sinus drainage in complicated frontal sinusitis are critical.

Keywords: Frontal sinusitis, brain abscess, posterior table defect, endoscopic sinus surgery, T-tube

Abstract

Skeletal muscle metastasis from lung cancer is a rare manifestation that often presents significant diagnostic challenges in clinical practice. We report the case of a 58-year-old man with a 25-pack-year smoking history who was diagnosed with lung squamous cell carcinoma following evaluation for persistent cough. Initial staging revealed no evidence of distant metastasis, and the patient was treated with systemic chemotherapy, which resulted in stable disease. Nine months later, the patient presented with a gradually enlarging and painful mass in the right gluteal region. Magnetic resonance imaging revealed a cystic intramuscular lesion with mural nodular components within the gluteus maximus muscle. Ultrasound-guided biopsy confirmed metastatic squamous cell carcinoma morphologically consistent with the primary lung tumor. The patient subsequently received second-line chemotherapy.

Keywords: Lung Neoplasms, Squamous cell carcinoma, Soft tissue lesions, Gluteus Muscles